Incidence of surgical rib fixation at chest wall injury society collaborative centers and a guide for expected number of cases (CWIS-CC1)

Evert Austin Eriksson*, Mathieu Mathilde Eugene Wijffels, Adam Kaye, Joseph Derek Forrester, Manuel Moutinho, Sarah Majerick, Zachary Mitchel Bauman, Christopher Francis Janowak, Bhavik Patel, Martin Wullschleger, Leanna Clevenger, Esther M.M. Van Lieshout, Jamie Tung, Michelle Woodfall, Thomas Russell Hill, Thomas William White, Andrew Ross Doben

*Corresponding author for this work

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Surgical stabilization of rib fractures (SSRF) improves outcomes in certain patient populations. The Chest Wall Injury Society (CWIS) began a new initiative to recognize centers who epitomize their mission as CWIS Collaborative Centers (CWIS-CC). We sought to describe incidence and epidemiology of SSRF at our institutions. 


A retrospective registry evaluation of all patients (age > 15 years) treated at international trauma centers from 1/1/20 to 7/30/2021 was performed. Variables included: age, gender, mechanism of injury, injury severity score, abbreviated injury severity score (AIS), emergency department disposition, length of stay, presence of rib/sternal fractures, and surgical stabilization of rib/sternal fractures. Classification and regression tree analysis (CART) was used for analysis. 


Data were collected from 9 centers, 26,084 patient encounters. Rib fractures were present in 24% (n = 6294). Overall, 2% of all patients underwent SSRF and 8% of patients with rib fractures underwent SSRF. CART analysis of SSRF by AIS-Chest demonstrated a difference in management by age group. AIS-Chest 3 had an SSRF rate of 3.7, 7.3, and 12.9% based on the age ranges (16–19; 80–110), (20–49; 70–79), and (50–69), respectively (p = 0.003). AIS-Chest > 3 demonstrated an SSRF rate of 9.6, 23.3, and 39.3% for age ranges (16–39; 90–99), (40–49; 80–89), and (50–79), respectively (p = 0.001). 


Anticipated rate of SSRF can be calculated based on number of rib fractures, AIS-Chest, and age. The disproportionate rate of SSRF in patients age 50–69 with AIS-Chest 3 and age 50–79 with AIS-Chest > 3 should be further investigated, as lower frequency of SSRF in the other age ranges may lead to care inequalities.

Original languageEnglish
Pages (from-to)417-423
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number2
Publication statusPublished - Apr 2024

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© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023.


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